Stanford type A aortic dissection, complicated with ascending aortic aneurysm and cardiac tamponade secondary due to rupture into pericardium.

Active contrast extravasation into the false lumen and pericardial space via intimal tear is worrisome sign for acute expansion of hematoma.

Undeniably, aortic dissection might lead to abnormal electrocardiogram ECG and causing incorrect diagnosis of ACS.
This case showed the importance to differentiate the diagnoses between acute coronary syndrome and aortic dissection, as the treatment for ACS with anticoagulants are disastrous for aortic dissection as depicted in this case.

Comparison the basic chest radiographs will give high yield on detection of rupture of aortic dissection.